Early open mitral valve surgery following arterial embolism.

A report is presented of nine patients who underwent early open mitral valve surgery after arterial embolism had occurred. Five of these patients suffered an early second arterial embolism before their mitral operation, an observation which stresses the risk inherent in delay of mitral valve surgery. The demonstration of atrial thrombi in four illustrates the potential danger of closed valvotomy techniques in such cases. Advanced pathological changes and severe stenosis of the mitral valve were found in all nine patients; valve replacement had to be done in three. All nine patients are alive and well after follow-up from 6 to 42 months. No further thrombo-embolic events have occurred after mitral valve surgery. Peripheral arterial embolism is a common complication of mitral stenosis and is accepted by many as an indication for mitral commissurotomy recommended early cardiac surgery, whereas others take a more conservative approach (Taber eventual surgical intervention may still be carried out using a closed valvotomy technique (Glenn We believe that delay of intervention and the use of 'closed' techniques are ill advised and even hazardous. Our experience, described below, leads us to recommend early, direct vision mitral valve surgery as soon as feasible after the embolic event. Nine patients have undergone 'open' mitral valve surgery following arterial embolism during the last three and a half years. Seven women and two men are included in this group. Their ages range from 19 to 60 years. Except for the two youngest, all had atrial fibrillation at the time of the embolic episodes. Six patients were without cardiac symptoms and mitral valve disease was not even suspected in four of them, the only call to medical attention being the acute arterial obstruction. One patient experienced three episodes of peripheral embolism before the diagnosis of mitral disease was proved. Two others suffered two embolic events before diagnosis of the mitral stenosis. In two patients the diagniosis was made at the time of the first arterial embolism, but they had another embolic event while awaiting cardiac surgery. Seven embolectomies were performed in five patients as the initial therapy (two patients had recurrent emboli necessitating repeat embolec-tomy). All the peripheral embolectomies in this series were successful in restoring circulation to the affected limbs. Three patients had central retinal emboli and two suffered from cerebral emboli, one remaining with residual hemiplegia and speech difficulties. The shortest time elapsing between ithe patient's last embolism and the …